Bilateral health agreements of South Africa: an analysis of issues covered

J Hanefeld, Moeketsi Modisenyane, Vearey Jo, Richard D Smith, Helen Walls, Neil Lunt

Research output: Contribution to journalArticlepeer-review

Abstract

The bilateral agreements signed between South Africa and countries in Southern and Eastern Africa are a rare example of efforts to regulate health-related issues in a region. As far as we know, there are not comparable bilateral health governance mechanisms in regions elsewhere. Furthermore, the rapidly growing literature on global health governance and governance for global health has to date not addressed the issue of patient mobility and how to govern it. In this study, we examine the issues included in these agreements, and highlight key issues that they address, identify areas of omission, and provide recommendations for improvement. This analysis should inform the development of such governance agreements both in Southern Africa and in regions elsewhere. We obtained 13 bilateral health agreements between South Africa and 11 neighbouring African countries as part of a broader research project examining health systems impact of patient mobility in South Africa, and thematically analysed their content and the governance mechanisms described. The agreements appear to be solidarity mechanisms between neighbouring countries. They contain considerable content on health diplomacy, with little on health governance, management and delivery. Nonetheless, given what they do and do not address, and how, they provide rare insight into mechanisms of global health diplomacy and attempts to address patient mobility and other health-related issues in practice. The agreements appear to be global health diplomacy mechanisms expressing solidarity, emerging from a post-apartheid period, but with little detail of issues covered, and a range of important issues not addressed. Further empirical work is required to understand what these documents mean, particularly in the Covid-19 context, and to understand challenges with their implementation. The documents also raise need for particular study of bilateral flows and experience of patients and health workers, and how this relates to health system strengthening.
Original languageEnglish
Pages (from-to)722-730
JournalHealth Policy and Planning
Volume39
Issue number7
Early online date25 May 2024
DOIs
Publication statusPublished - Aug 2024

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